Ultrasound-guided oblique approach for peripheral venous access in a phantom model

In a prospective, case control study, EPs were enrolled from four levels of physician experience including postgraduate years one to three (PGY1, PGY2, PGY3) and attending physicians. After a brief training session, each participant attempted vessel aspiration using a linear probe in T, L, and O axes on a gel US phantom. Time to aspiration and number of attempts to aspiration were recorded. The approach order was randomized, and descriptive statistics were used.Twenty-four physicians participated. The first-attempt success rate was lower for O, 45.83%, versus 70.83% for T (p？=？0.03) and 83.33% for L (p？=？0.01). The average time to aspiration was 12.5 s (O) compared with 9.47 s (T) and 9.74 s (L), respectively. There were no significant differences between all four groups in regard to total amount of time and number of aspiration attempts; however, a trend appeared revealing that PGY3 and attending physicians tended to aspirate in less time and by fewer attempts in all three orientations when compared with the PGY2 and PGY1 physicians.In this pilot study, US-guided simulated peripheral venous access using a phantom gel model in a mixed user group showed that the novel oblique approach was not initially more successful versus T and L techniques.Peripheral venous access is commonly employed in the emergency department (ED) to obtain blood samples and to administer intravenous medications and fluids. In certain patient populations, the ability to access a vessel is often limited by the ability to locate the vessel by blind aspiration. With increasing frequency, ED physicians have sought to use ultrasound guidance to obtain peripheral lines [1-6].Traditionally, a transverse or longitudinal sonographic view is used to access a vessel. Each of these approaches has unique advantages and disadvantages. The transverse view allows for the target vessel and its surrounding structures to be seen simultaneously on the screen; however, the needle tip can be lost from view, and pos